Publications

Digital mammographic density and breast cancer risk: a case-control study of six alternative density assessment methods

Eng, Gallant, Shepherd, McCormack, Li, Dowsett, Vinnicombe, Allen & dos-Santos-Silva
Breast Cancer Res 2014
​“PD [percent density] was positively associated with breast cancer for all methods, but with the increase in risk per standard deviation increment in PD being highest for Volpara (1.83; 95% CI: 1.51 to 2.21)…Women in the top PD quintile (or BI-RADS 4) had 8.26 (4.28 to 15.96), times the risk of those in the bottom one (or BI-RADS 1)…for Volpara…”
Read article
Eng et al., Breast Cancer Res 2014; 20;16(5):439. doi: 10.1186/s13058-014-0439-1.

Automated measurement of volumetric mammographic density: a tool for widespread breast cancer risk assessment

Brand, Czene, Shepherd, Leifland, Heddson, Sundbom, Erikssonm Li, Humphreys & Hall
Cancer Epidemiol Biomarkers Prev 2014
“Percent and absolute dense volumes as obtained with Volpara are associated with established determinants of mammographic density as well as breast cancer risk… our results suggest that automated measurement of volumetric mammographic density can be used as part of screening programs to provide risk and masking information that could be used to alter woman’s clinical management…”
Read abstract
Brand et al., Cancer Epidemiol Biomarkers Prev 2014; 23(9):1764-72. doi: 10.1158/1055-9965.EPI-13-1219

High volumetric breast density predicts risk for breast cancer in postmenopausal, but not premenopausal, Korean women

Park, Ko, Joo, Park, Jung, Lee, Kwon, Kang, Lee, Lee & Ro
Ann Surg Oncol 2014
“High VBD [as measured by Volpara software version 1.5.1] is associated with a risk of breast cancer with specific characteristics in postmenopausal women; however, these relationships were not found in premenopausal Korean women.”
Read abstract
Park et al., Ann Surg Oncol 2014; 21(13):4124-32. doi: 10.1245/s10434-014-3832-1

Volumetric mammographic density: heritability and association with breast cancer susceptibility loci

Brand, Humphreys, Thompson, Li, Eriksson, Hall & Czene
J Natl Cancer Inst
"Our results support the high heritability of mammographic density, though estimates are weaker for absolute than percent dense volume​"​
Read abstract
Brand et al., J Natl Cancer Inst. 2014;106(12) doi: 10.1093/jnci/dju334

Volumetric breast density estimation from full-field digital mammograms: a validation study

Gubern-Mérida, Kallenberg, Platel, Mann, Martı & Karssemeijer
PLoS One 2014
"…our study shows that it is feasible to obtain accurate measurements of absolute and relative volumes of dense breast tissue from full field digital mammograms. Availability of such measurements is crucial for the development of objective breast cancer risk models and may be used in the development of personalized screening protocols."
Read paper
Gubern-Mérida et al., PLoS One 2014; 9(1):e85952. doi: 10.1371/journal.pone.0085952

Agreement of mammographic measures of volumetric breast density to MRI

Wang, Azziz, Fan, Malkov, Klifa, Newitt, Yitta, Hylton, Kerlikowske & Shepherd
PLoS One 2013
"Automated volumetric fibroglandular tissue measures from screening digital mammograms were in substantial agreement with MRI and if associated with breast cancer could be used in clinical practice to enhance risk assessment and prevention."
Read paper
Wang et al., PLos One 2013; 8(12):e81653. doi: 10.1371/journal.pone.0081653

Comparison of mammographic density estimation by Volpara software with radiologists' visual assessment: analysis of clinical-radiologic factors affecting discrepancy between them

Lee, Sohn & Han
Acta Radiol 2014
"Therefore, the use of automated software may help provide higher reproducibility, especially for patients with different bilateral breast densities... In conclusion, automated volumetric breast density measurement shows good agreement of BI-RADS density category as a quantitative method."
Read abstract
Lee et al., Acta Radiol 2014 [Epub ahead of print] pii: 0284185114554674

Patient specific dose calculation using volumetric breast density for mammography and tomosynthesis

Tromans, Highnam, Morrish, Black. Tucker, Gilbert & Brady
IWDM 2014
“…to calculate accurate MGD estimates the patient specific glandularity should be included… When comparing MGD in “combo” mode tomosynthesis / mammography examinations, at lower breast density the mammographic MGD is lower than in tomosynthesis, but at higher density the MGDs are approximately equal.”
Read abstract
Tromans et al., 12th International Workshop on Breast Imaging, June 29 ‐ July 2 2014, Gifu City, Japan. LNCS 8539. doi: 10.1007/978‐3‐319‐07887‐8_23.

Mammographic compression ‐ A need for mechanical standardization

Branderhorst, de Groot, Highnam, Chan, Böhm‐Vélez, Broeders, den Heeten & Grimbergen
Eur J Radiol 2015
"Pressure standardization using Volpara could decrease variation, improve reproducibility, and reduce the risk of unnecessary pain, unnecessary high radiation doses and inadequate image quality."
Read abstract
Branderhorst, de Groot, Highnam, Chan, Bohm-Velez & Broeders. Eur J Radiol. 2015;84(4):596-602. doi: 10.1016/j.ejrad.2014.12.012

Volumetric breast density improves breast cancer risk prediction

Harvey, Stukenborg, Cohn, Repich, Novicoff, Alonzo, Yaffe & Knaus
San Antonio Breast Cancer Symposium 2014
​"Mean volumetric breast density [using Volpara] was a leading independent predictor of case status in the full (p<0.0001), reduced models (A: p=0.0212, B: p=0.0011), and minimal model (p=0.0046). The addition of volumetric breast density improved breast cancer risk discrimination… Even the minimal model that includes only 13 covariates demonstrates improved discrimination (0.82) compared with the Tyrer-Cuzick (IBIS) model (0.74)."
Read poster
Harvey et al., San Antonio Breast Cancer Symposium, December 9-13, 2014. San Antonio TX. P6-09-04

Volumetric breast density affects performance of digital screening mammography

Wanders, Holland, Veldhuis, Mann, , Pijnappel, Peeters, van Gils & Karssemeijer
Breast Cancer Res Treat 2016
"Volumetric mammographic density, automatically measured on digital mammograms, impacts screening performance measures along the same patterns as established with ACR breast density categories."

Read article
Wanders et al., Breast Cancer Res Treat, 2016, doi: 10.1007/s10549-016-4090-7. [Epub ahead of print]

 

Performance of Breast Cancer Screening Depends on Mammographic Compression

Holland, Sechopoulos, den Heeten, Mann & Karssemeijer
IWDM 2016
"The results suggest that high pressure reduces detectability of breast cancer. The best screening results were found in the groups with a moderate pressure."
Read abstract
Holland et al., pg176 of proceedings of 13th International Workshop on Breast Imaging IWDM. June 19-22 2016, Malmö, Sweden

Rajaram, Mariapun, Eriksson, Tapia, Kwan, Ho, Harun, Rahmat, Czene, Taib, Hall, Teo
Breast Cancer Res Treat 2016
"Variation in dense volume for post-menopausal Asian and Caucasian women reflects population differences in breast cancer risk, and these are attributed to differences in height, weight, and parity. Further research is needed to identity a suitable mammographic density measure as a biomarker for breast cancer risk among pre-menopausal Asian women."
Read article
Rajaram et al., Breast Cancer Res Treat 2016 [Epub ahead of print] DOI 10.1007/s10549-016-4054-y

van der Waal, Emaus, Bakker, den Heeten, Karssemeijer, Pijnappel, Veldhuis, Verbeek, van Gils & Broeders
Eur Radiol. 2015
"There appears to be geographic variation in mammographic density in the Netherlands, emphasizing the importance of including breast density as parameter in the evaluation of screening performance."
Read article
van der Waal et al., European Radiology, 2015:3742. doi: 10.1007/s00330-015-3742-z

Emaus, Bakker, Peeters, Loo, Mann, de Jong, Bisschops, Veltman, Duvivier, Lobbes, Pijnappel, Karssemeijer,Koning, van den Bosch, Monninkhof, Mali, Veldhuis & van Gils
Radiology 2015
"In this study, mammographic density is measured by using a fully automated volumetric method. Participants with extremely dense breasts (American College of Radiology breast density category 4) and a negative result at mammography (Breast Imaging Recording and Data System category 1 or 2) are randomly assigned to undergo additional MR imaging (n = 7237) or to be treated according to current practice (n = 28 948)."
Read abstract
Emaus et al., Radiology, 2015:141827. doi: 10.1148/radiol.15141827

Lau, Ng & Aziz
World Congress on Medical Physics and Biomedical Engineering 2015
"We observed compression parameters were highly variable between and within women. We estimated the ‘ideal’ median compression force should be approximately 50% lower than our current practice. Further studies on the impact of pressure-standardized protocol on image quality and radiation dose in Asian women (who generally have smaller breasts) is of great importance."
Lau et al., World Congress on Medical Physics and Biomedical Engineering, June 7 – 12, 2015, Toronto, Canada.

Heller, Hudson & Wilkinson
ECR 2015
"Our study suggests that age, ethnicity, and socioeconomic status may have impact on breast density with relevance for identification of future cancer risk."
Read abstract
Heller et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Branderhorst, de Groot, Highnam, Chan, Böhm‐Vélez, Broeders, den Heeten & Grimbergen
Eur J Radiol 2015
"Pressure standardization using Volpara could decrease variation, improve reproducibility, and reduce the risk of unnecessary pain, unnecessary high radiation doses and inadequate image quality."
Read abstract
Branderhorst, de Groot, Highnam, Chan, Bohm-Velez & Broeders. Eur J Radiol. 2015;84(4):596-602. doi:10.1016/j.ejrad.2014.12.012

Ellison‐Loschmann, McKenzie, Highnam, Cave, Walker & Jeffreys
PLoS One 2013
"We used an automated system, VolparaTM, to measure breast density volume from the medio‐lateral oblique view of digital mammograms, by age (≤50 years and >50 years) and ethnicity (Pakeha/Māori/Pacific/Asian), using routine data from the national screening programme... we found differential patterns of breast density by ethnicity consistent with ethnic differences seen in breast cancer risk. Breast density may be a contributing factor to NZ's [New Zealand's] well known, but poorly explained, inequalities in breast cancer incidence."
Read paper
Ellison‐Loschmann et al., PLos One 2013; 8﴾7﴿:e70217. doi: 10.1371/journal.pone.0070217

Ng, Liew, Rahmat, Westerhout, Teh, Taib & Yip
ECR 2013
“Recognizing there are density differences between the ethnic groups in Malaysia, we need to tailor the screening program…to optimize its effectiveness”
Read abstract
Ng et al., European Congress of Radiology, March 7‐11, 2013, Vienna, Austria. doi: 10.1594/ecr2013/C‐1843

Alonzo-Proulx, Mawdsley, Patrie, Yaffe & Harvey
Radiology 2015
​"Variability in a repeated measurement of breast density is lowest for Volpara and Quantra; these algorithms may be more suited to incorporation into a risk model."
Read abstract
Alonzo-Proulx, et al. Radiology 2015:141686. doi: 10.1148/radiol.15141686

Schmachtenberg, Hammann-Kloss, Bick & Engelken
Acad Radiol 2015
"Although Quantra and Volpara use different models for analysis of volumetric breast density and produce different nominal results of FTV [fibroglandular tissue volume] and PD [percent density], both methods are highly correlated and show very good to excellent agreement in all parameters measured."
Read abstract
Schmachtenberg, et al., Acad Radiol 22(4): 447-452, 2015. doi: 10.1016/j.acra.2014.12.003

Kolb, Wang, Chang & Highnam
NCoBC 2015
​"Automated methods for assessing adequate breast positioning in mammography have the potential to improve the quality of mammographic images."
Read poster
Kolb et al., National Consortium of Breast Centers, March 14-18, 2015, Las Vegas.

Gennaro, Sechopoulos, Gallo, Rossetti & Highnam
ECR 2015
​“Dose values provided by manufacturers, using different models and assuming breast density a priori, are significantly different compared to those obtained after accounting for real differences among breast densities.”​
Read scientific exhibit
Gennaro et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Destounis, Highnam, Chan, Arieno & Morgan
RSNA 2014
"Manufacturer-reported radiation dose vary considerable over time and between manufacturer...This is important as patients are becoming increasingly concerned about radiation dose - we need some form of standardized values to ensure consistency in reporting dose."
Read abstract
Destounis et al., Radiological Society of North America Annual Meeting, November 30 - December 05, 2014, Chicago IL.

Böhm-Vélez, Highnam, Chan & Chang
RSNA 2014
"P-MGD [personalized mean glandular dose] estimates, which incorporate both individual breast densities and a manufacturer-independent dose algorithm, are essential for standardizing the assessment of radiation dose."
Read abstract
Böhm-Vélez et al., Radiological Society of North America Annual Meeting, November 30 - December 05, 2014, Chicago IL.

Pertuz, McDonald, Weinstein, Conant & Kontos
RSNA 2014
"Fully-automated 3D fibroglandular tissue segmentation and VBD [volumetric breast density] estimation from DBT [digital breast tomosynthesis] images is feasible and shows strong agreement with existing volumetric techniques based on DM [digital mammography] and MRI images."
Read abstract
Pertuz et al., Radiological Society of North America Annual Meeting, November 30 - December 05, 2014, Chicago IL.

Tromans, Highnam, Morrish, Black. Tucker, Gilbert & Brady
IWDM 2014
“…to calculate accurate MGD estimates the patient specific glandularity should be included… When comparing MGD in “combo” mode tomosynthesis / mammography examinations, at lower breast density the mammographic MGD is lower than in tomosynthesis, but at higher density the MGDs are approximately equal.”
Read abstract
Tromans et al., 12th International Workshop on Breast Imaging, June 29 ‐ July 2 2014, Gifu City, Japan. LNCS 8539. doi: 10.1007/978‐3‐319‐07887‐8_23.

Tromans, Chan & Highnam
ECR 2014
“Improved understanding and accurate monitoring of patient dose is important, but is complicated by the use of different algorithms by x‐ray vendors, which do not take into account the actual glandularity of the patient. Consistent personalized dose algorithms are essential for meaningful comparison of doses received by patients over time.”
Read scientific exhibit
Tromans et al., European Congress of Radiology. March 6‐10, 2014, Vienna, Austria. doi: 10.1594/ecr2014/C‐0360

Tromans, Highnam, Morrish, Black, Tucker & Gilbert
ECR 2014
“Volumetric methods produce reliable and objective breast density estimations for both raw conventional mammograms and raw tomosynthesis projections.”
Read scientific exhibit
Tromans et al. European Congress of Radiology. March 6‐10, 2014, Vienna, Austria. doi: 10.1594/ecr2014/C‐0363

Patel, Highnam, Tromans, Pizzutiello & Destounis
AAPM 2013
“Dose estimations implemented by manufacturers may underestimate the actual patient AGD significantly as they do not account for the specific breast tissue composition, compressed breast thickness or x-ray beam parameters of the specific mammography system used. Patient-specific dose estimates may give a better indication of the actual dose delivered, and therefore the risk to the patient.”​
Read abstract
Patel et al., American Association of Physicists in Medicine Annual Meeting, August 4-8, 2013, Indianapolis IN. SU-C-116-1

Porras-Chaverri, Vetter & Highnam
AAPM 2013
“We have developed a method to obtain estimations of the glandular tissue distribution from conventional mammography images using their corresponding breast density maps. Our work provides a methodology to incorporate anatomical information in the calculation of patient-oriented MGD, thereby overcoming one of the known limitations of the currently used mammography dosimetry methods.”
Read abstract
Porras-Chaverri et al., American Association of Physicists in Medicine Annual Meeting, August 4-8, 2013, Indianapolis IN. doi: 10.1118/1.4815668

Porras-Chaverri, Vetter & Highnam
IWDM 2012
“…patient-specific calculations of mean glandular dose…variation in mean glandular dose was as large as 14.8% for a highly heterogeneous dense breast”​​
Read abstract
Porras-Chaverri et al., Proceedings of the 11th International Workshop of Breast Imaging. July 8-11, 2012, Philadelphia PA. LNCS 7361. doi: 10.1007/978-3-642-31271-7_18

Lau, Ng & Aziz
BJR 2016
“Volpara was robust to expected clinical variations, with errors in most investigated parameters giving limited changes in results...”
Read paper
Lau et al., Volumetric breast density measurement: sensitivity analysis of a relative physics approach. BJR 2016 DOI: http://dx.doi.org/10.1259/bjr.20160258

Baker & Highnam
BIG ‐ 9th General Breast Imaging Meeting 2013
“An automated, objective breast density measure integrated smoothly into our workflow. The real, physical nature of the volumetric results, and the fact that the results were available almost immediately, greatly facilitated communicating breast density results and their significance to patients.”
Read abstract
Baker & Highnam, 9th Breast Imaging Group Meeting, June 3-7, 2013, Darwin, Australia.

Gennaro & Highnam
ECR 2013
“Volumetric breast density software allows extraction of objective data on breast density which have potential to become helpful in tailoring patient workups”
Read abstract
Gennaro & Highnam, European Congress of Radiology, March 7‐11, 2013, Vienna, Austria. doi: 10.1594/ecr2013/C‐1033

Holland, van Zelst, den Heeten, Imhof-Tas, Mann, van Gils & Karssemeijer
The Breast 2016
“The categorization of serial mammograms in density classes is more consistent with automated software than with a mixed group of human readers. When using breast density to personalize screening protocols, assessment with software may be preferred over assessment by radiologists.”
Read paper
Holland et al. Consistency of breast density categories in serial screening mammograms: A comparison between automated and human assessment. The Breast 29 (2016) 49-54

Vohra, Kachare, Vos, Schroeder, Schuth, Suttle, Fitzgerald, Wong & Verbanac
Obesity Surgery 2016
“Breast volume and fibroglandular volume decreased, and VBD increased following WLS (weight loss surgery), with the most significant change observed in postmenopausal women and non-diabetics.​”
Read paper
Vohra NA et al. 2016 "The Short-Term Effect of Weight Loss Surgery on Volumetric Breast Density and Fibroglandular Volume" OBES SURG doi:10.1007/s11695-016-2415-6

Wang, Chan & Highnam
ECR 2015
“Volpara demonstrated excellent temporal consistency and reproducibility in women undergoing screening over time, and the assessment of breast density was robust to the presence of breast lesions.”​
Read scientific exhibit
Wang et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Lin, Sauber & Highnam
ECR 2013
“The “For Presentation” images that radiologists use to assess breast density are not reliable for monitoring changes over time…We have an objective method for transforming sequential mammogram images into temporal movies.”
Read abstract
Lin et al., European Congress of Radiology, March 7-11 2013, Vienna, Austria. doi: 10.1594/ecr2013/C-1770

Kallenberg & Karssemeijer
ECR 2013
“…in a large screening population…fully automatic volumetric breast density estimation shows good temporal stability”
Read abstract
Kallenberg et al., European Congress of Radiology, March 7-11, 2013, Vienna, Austria. doi: 10.1594/ecr2013/C-1953

Highnam & Schroeder
IWBD 2011
“Assessing temporal change on a whole breast basis is possible, but we firmly believe it should be on a continuous measure to avoid border category issues.”
Read abstract
Highnam et al., Proceedings of the 5th International Workshop on Breast Densitometry and Breast Cancer Risk Assessment. June 9-10, 2011, San Francisco CA.

Edwards, Atkins, Stukenborg, Novicof, Larson, Cohn, Harvey & Schroen
San Antonio Breast Cancer Symposium 2014
"The association between Her-2-neu positive tumors and denser breasts using continuous quantitative [Volpara] measurements is significant (p=0.035)…utilizing categorical BIRADS breast density, this association is not clearly seen among women having heterogeneously dense (p=0.671) or extremely dense breast (p=0.099)."
Read poster
Sharping et al., San Antonio Breast Cancer Symposium, December 9-13, 2014. San Antonio TX. P2-04-04

Ren, Harkness, Boggis, Gadde, Wilson, Lim, Sergeant, Whiteside, Morris & Astley
IWDM 2014
“The median percentage density by Volpara of women with invasive cancers was significantly higher than those with DCIS… Further analysis showed a significant positive association between whole tumour size and volumetric density for invasive lesions.”​
Read abstract
Ren et al., Proceedings of the 12th International Workshop on Breast Imaging. June 29 - July 2, 2014, Gifu City, Japan. LNCS 8539. doi: 10.1007/978-3-319-07887-8_41

Bozek, Kallenberg, Grgic & Karssemeijer
IWDM 2012
“Size of a lesion presented by its area might not be as reliable as volume of a lesion…volume might be better than area for comparing lesion size in two consecutive exams and for evaluating temporal change to distinguish benign and malignant lesions”
Read abstract
Bozek et al., Proceedings of the 11th International Workshop of Breast Imaging. July 8-11, 2012, Philadelphia PA. LNCS 7361. doi: 10.1007/978-3-642-31271-7_13

Lundberg, Johansson, Rodroguez-Wallberg, Brand, Czene, Hall & Iliadou
Breast Cancer Res 2016
"Women with a history of infertility had higher absolute dense volume than other women. Among the infertile women, those who had gone through COS [controlled ovarian stimulation] had the highest absolute dense volume."
Read paper
Lundberg et al., Breast Cancer Res., 2016 (18): 36 doi: 10.1186/s13058-016-0693-5

McConnell, O'Connell, Brennan, Weiping, Howe, Joseph, Knight, O'Cualain, Lim, Leek, Waddington, Rogan, Astley, Gandhi, Kirwan, Sherratt & Streli
Breast Cancer Res 2016
"These preliminary data suggest that remodelling, and hence stiffening, of the existing stromal collagen microarchitecture promotes high mammographic density within the breast. In turn, this aberrant mechanical environment may trigger neoplasia-associated mechanotransduction pathways within the epithelial cell population"​
Read paper
McConnell et al. 2016 Breast Cancer Res 18 (5) DOI 10.1186/s13058-015-0664-2

Trinh, Christensen, Brand, Cuzick, Czene, Sjolander, Balter & Hall
Br J Cancer 2015
"…increasing alcohol consumption was associated with higher absolute dense volume (cm3) and percent dense volume (%). The association between alcohol consumption and absolute dense volume was most pronounced among women with the highest (≥5%) Tyrer-Cuzick 10-year risk."​
Read abstract
Trinh et al., Br J Cancer 2015. [Epub ahead of print] doi: 10.1038/bjc.2015.185

Brand, Li, Humphreys, Karlsson, Eriksson, Ivansson, Hall & Czene
Breast Cancer Res 2015
"…we identified two novel MD loci at 6q25.1 in a large scale genotyping effort of semi- and fully automated MD measures, which have previously been associated with breast cancer risk."​
Read abstract
Brand et al., Breast Cancer Res 2015 [Epub ahead of print] doi: 10.1186/s13058-015-0591-2

Skarping, Brand, Hall & Borgguist
BMC Cancer 2015
"We used a fully-automated method for measuring mammographic density, which in contrast to other methods is not prone to subjective measurement error. Moreover, volumetric approaches yield more accurate density measures... we found no strong evidence for an overall effect of statin use on volumetric mammographic density in terms of absolute dense volume... a larger absolute dense volume in statin users, who also reported HRT use, requires further investigation."​
Read paper
Skarping et al., BMC Cancer. 2015;15:435. doi: 10.1186/s12885-015-1457-9

Winkler, Raza, Mackesy & Birdwell
RadioGraphics 2015
"Therefore, volumetric density calculations may provide the most accurate, reliable, and reproducible method of density assessment and may have more meaningful clinical implications than subjective density assessments."​
Read abstract
Winkler et al., RadioGraphics. 2015; 35:316-324. doi: 10.1148/rg.352140134

Brand, Humphreys, Thompson, Li, Eriksson, Hall & Czene
J Natl Cancer Inst
"Our results support the high heritability of mammographic density, though estimates are weaker for absolute than percent dense volume​"​
Read abstract
Brand et al., J Natl Cancer Inst. 2014;106(12) doi: 10.1093/jnci/dju334

Highnam, Sauber, Destounis, Harvey & McDonald
IWDM 2012
​“…Volpara…ready for actual clinical use and how it is impacting patient management.”​​
Read abstract
Highnam et al., Proceedings of the 11th International Workshop of Breast Imaging. July 8-11, 2012, Philadelphia PA. LNCS 7361. doi: 10.1007/978-3-642-31271-7_60

Schroeder, Highnam, Cave, Walker, Karssemeijer & Yaffe
RSNA 2011
“…Personalized risk/benefit analyses, including breast density assessment, may provide more suitable guidance for appropriate utilization of medical resources.”​​
Read abstract
Schroeder et al., Proceedings of the Radiological Society of North America 2011 Scientific Assembly and Annual Meeting. November 26- December 2, 2011, Chicago IL.

Brandt, Scott, Ma, Mahmoudzadeh, Whaley, Wu, Malkov, Hruska, Norman, Heine, Shepherd, Pankratz, Kerlikowske & Vachon
Radiology 2016
"Automated and clinical assessments of breast density are similarly associated with breast cancer risk but differ up to 14% in the classification of women with dense breasts."
Read paper
Brandt et al., Radiology, 2016 (279): 710 doi: 10.1148/radiol.2015151261

Brand, Czene, Shepherd, Leifland, Heddson, Sundbom, Erikssonm Li, Humphreys & Hall
Cancer Epidemiol Biomarkers Prev 2014
“Percent and absolute dense volumes as obtained with Volpara are associated with established determinants of mammographic density as well as breast cancer risk… our results suggest that automated measurement of volumetric mammographic density can be used as part of screening programs to provide risk and masking information that could be used to alter woman’s clinical management…”
Read abstract
Brand et al., Cancer Epidemiol Biomarkers Prev 2014; 23(9):1764-72. doi: 10.1158/1055-9965.EPI-13-1219

Trinh, Eriksson, Darabi, Bonn, Brand, Cuzick, Czene, Sjölander, Bälter & Hall
Breast Cancer Res 2015
"...higher levels of physical activity were associated with lower absolute dense volume and nondense volume, but seemed to be associated with higher percent dense volume... absolute dense volume seemed to vary according to the risk of developing breast cancer in the next 10 years...Volumetric measures are therefore expected to capture the actual amount of fibroglandular tissue in the breast more precisely."
Read abstract
Trinh et al. Breast Cancer Res. 2015;17:50. doi: 10.1186/s13058-015-0565-4

Ciatti, Gennaro, Mungai & Nannini
ECR 2015
"Lifetime risk increases with breast density. Volumetric mammographic density measure might be used with existing risk prediction models to identify high-risk women more precisely."
Read abstract
Ciatti et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Heller, Hudson & Wilkinson
ECR 2015
​“…in our cohort, 15% of prevalent round women have very dense breasts (Volpara Grade 4). We note that the cancer detection rate in these women was 40% higher than average prevalent round detection rate.”​
Read abstract
Heller et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Park, Ko, Joo, Park, Jung, Lee, Kwon, Kang, Lee, Lee & Ro
Ann Surg Oncol 2014
“High VBD [as measured by Volpara software version 1.5.1] is associated with a risk of breast cancer with specific characteristics in postmenopausal women; however, these relationships were not found in premenopausal Korean women.”
Read abstract
Park et al., Ann Surg Oncol 2014; 21(13):4124-32. doi: 10.1245/s10434-014-3832-1

Howell, Astley, Harkness, Wiseman, Fox, Stavrinos, Wilson, Lim, Reece, Beetles, Jain, Sergeant, Cuzick, Warren & Evans
San Antonio Breast Cancer Symposium 2014
"a greater than 10% reduction in dense volume was seen in 68% of women for Quantra and 72% for Volpara...Absolute measures of dense area and dense volume show greatest changes and may be most useful for clinical practice"​
Read poster
Howell et al., San Antonio Breast Cancer Symposium, December 9-13, 2014. San Antonio TX. P5-12-01

Harvey, Stukenborg, Cohn, Repich, Novicoff, Alonzo, Yaffe & Knaus
San Antonio Breast Cancer Symposium 2014
​"Mean volumetric breast density [using Volpara] was a leading independent predictor of case status in the full (p<0.0001), reduced models (A: p=0.0212, B: p=0.0011), and minimal model (p=0.0046). The addition of volumetric breast density improved breast cancer risk discrimination… Even the minimal model that includes only 13 covariates demonstrates improved discrimination (0.82) compared with the Tyrer-Cuzick (IBIS) model (0.74)."
Read poster
Harvey et al., San Antonio Breast Cancer Symposium, December 9-13, 2014. San Antonio TX. P6-09-04

Gilbert, Duffy, Morrish, Tucker & Black
RSNA 2014
“There was a significant (p<0.001) 3% (95% CI 1-5%) increased risk of breast cancer per 10 cm3 increase in fibroglandular (dense) tissue measured by Volpara… Automated volumetric breast density is predictive of breast cancer risk. There is evidence that it has stronger predictive power for potentially fatal large and grade 3 invasive cancers.”
Read abstract
Gilbert et al., Radiological Society of North America Annual Meeting, November 30 - December 05, 2014, Chicago IL.

Eng, Gallant, Shepherd, McCormack, Li, Dowsett, Vinnicombe, Allen & dos-Santos-Silva
Breast Cancer Res 2014
​“PD [percent density] was positively associated with breast cancer for all methods, but with the increase in risk per standard deviation increment in PD being highest for Volpara (1.83; 95% CI: 1.51 to 2.21)…Women in the top PD quintile (or BI-RADS 4) had 8.26 (4.28 to 15.96), times the risk of those in the bottom one (or BI-RADS 1)…for Volpara…”
Read article
Eng et al., Breast Cancer Res 2014; 20;16(5):439. doi: 10.1186/s13058-014-0439-1.

Cheddad, Czene, Eriksson, Li, Easton, Hall & Humphreys
PLoS One 2014
​“All three automated PD [Percent Density] measures were associated with rs10995190, after adjusting for age, BMI, menopausal status, HRT use, parity and age at first birth.”
Read abstract
Cheddad et al., PLoS One 2014; 9(10):e110690. doi: 10.1371/journal.pone.0110690

Yoo, Kim, Cha, Shin & Chae
KCR 2013
“On logistic regression analysis, VBD, FGV, and TBV showed significant associations with breast cancer risk and odds ratios were 4.1 for VBD, 1.4 for FGV, and 1.03 for TBV…These automatic quantitative parameters could be expected to help stratify breast cancer risk according to breast density.”​
Read abstract
Yoo et al., Proceedings of the 69th Korean Congress of Radiology and Annual Delegate Meeting of the Korean Society of Radiology. October 9-12, 2013, Seoul, Korea.

Kallenberg, Holland, Wanders, van Gils & Karssemeijer
IWBD 2013
“High volume of fibroglandular tissue, as assessed by a robust, automated method, is associated with breast cancer, and may hence offer opportunities for personalised breast cancer screening. Future analyses that will include interval tumors as well, are expected to provide even stronger risk estimates…”​
Read poster
Kallenberg et al., 6th International Breast Densitometry and Breast Cancer Risk Assessment Workshop, June 6-7 2013, San Francisco CA

Kallenberg, van Gils, Mann & Karssemeijer
RSNA 2012
“High volumetric breast density, as assessed by a robust, automated method, is associated with both breast cancer and false positive referrals”​​​
Read abstract
Kallenberg et al., Proceedings of the Radiological Society of North America 2012 Scientific Assembly and Annual Meeting. November 25-30, 2012, Chicago, IL. SSK01-02

Yaffe & Alonzo-Proulx
IWDB 2011
“…For volumetric breast density, the relative risk was…2.7 ± 0.8 for Volpara [no adjustment for BMI]”
Read abstract
Yaffe & Alonzo-Proulx., Proceedings of the 5th International Workshop on Breast Densitometry and Breast Cancer Risk Assessment. June 9-10 2011, San Francisco CA

Gubern-Mérida, Kallenberg, Platel, Mann, Martı & Karssemeijer
PLoS One 2014
"…our study shows that it is feasible to obtain accurate measurements of absolute and relative volumes of dense breast tissue from full field digital mammograms. Availability of such measurements is crucial for the development of objective breast cancer risk models and may be used in the development of personalized screening protocols."
Read paper
Gubern-Mérida et al., PLoS One 2014; 9(1):e85952. doi: 10.1371/journal.pone.0085952

Wang, Azziz, Fan, Malkov, Klifa, Newitt, Yitta, Hylton, Kerlikowske & Shepherd
PLoS One 2013
"Automated volumetric fibroglandular tissue measures from screening digital mammograms were in substantial agreement with MRI and if associated with breast cancer could be used in clinical practice to enhance risk assessment and prevention."
Read paper
Wang et al., PLos One 2013; 8(12):e81653. doi: 10.1371/journal.pone.0081653

McCormack, Aitken, dos Santos Silva & Highnam
IWDB 2011
"…Volumetric density measurements are consistent with what would be expected of the known epidemiology of mammographic density."
Read abstract
McCormack et al., Proceedings of the 5th International Workshop on Breast Densitometry and Breast Cancer Risk Assessment. June 9-10 2011, San Francisco CA

Jeffreys, Harvey & Highnam
IWDM 2010
"…compare...Volpara to an expert’s BIRADS visual assessment and Cumulus and show that all are closely related"
Read abstract
Jeffreys et al., Proceedings of the 10th International Workshop of Digital Mammography. June 16-18 2010, Girona, Spain. LNCS 6136. doi: 10.1007/978-3-642-13666-5_55

Destounis, Johnston, Highnam, Arieno, Morgan & Chan
Am J Roentgenol 2016
"Quantitative VBD captures the potential masking risk of breast density more precisely than does the widely used visual BI-RADS density classification system."
Read paper
Destounis et al., Am J Roentgenol, 2016, 8:1-6 [Epub ahead of print]

Destounis, Arieno & Morgan
J Ultrasound Med 2015
"We report a similar [cancer detection] rate, as we found 2.1 per 1000 [screening ultrasounds]... since the New York State breast density mandate, we found that handheld screening breast sonography performed in women with dense breast tissue can aid in the detection of otherwise occult breast cancer..."
Read abstract
Destounis et al., J Ultrasound Med. 2015;34:993-1000. doi: 10.7863/ultra.34.6.993

Wanders, Holland, Veldhuis, Mann, Peeters, van Gils & Karssemeijer
ECR 2015
"…when FFDM is used in breast cancer screening, higher interval cancer and false-positive rates are observed in women with mammographically dense breasts."
Read abstract
Wanders et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Salvagnini, Bosmans, Van Ongeval, Van Steen, Michilesen, Cockmartin, Struelens & Marshall
ECR 2015
"…detectability falls as breast thickness increases, especially for compressed breast thickness above 49mm."
Read scientific exhibit
Salvagnini et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Karssemeijer, Hupse, den Heeten, Lobbes & Mann
ECR 2014
"Multiple independent readers improved cancer detection rates, and may be an effective way to deal with dense mammograms, which are more difficult to read."
Read poster
Karssemeijer et al., European Congress of Radiology. March 6-10, 2014, Vienna, Austria. doi: 10.1594/ecr2014/C-0.58

Raza, Mackesy, Winkler, Hurwitz & Birdwell
J Am Coll Radiol 2016
"Training may improve the accuracy of mammographic breast density assessment. Substantial agreement between qualitative and quantitative breast density assessment exists."
Read paper
Raza et al., J Am Coll Radiol, 2016(13)310-315.

van der Waal, den Heeten, Pijnappel, Schuur, Timmers, Verbeek & Broeders
PLoS One 2015
"There appeared to be a strong association of these measures (Quantra and Volpara) with each other and with the BI-RADS density scale...If studies indeed show that breast density is important for evaluating performance or could be useful for risk stratification, then both Quantra and Volpara may be considered."
Read paper
van der Waal, D. et al., PLoS One. 2015; 10(9):e0136667

Morrish, Tucker, Black, Willsher, Duffy & Gilbert
Radiology 2015
"Comparison of observer’s scores with the area-based density given by Quantra yielded a low correlation (r = 0.55, P < .001). Correlations of observer’s scores with the volumetric density results gave r values of 0.60 (P < .001) and 0.63 (P < .001) for Quantra and Volpara, respectively."
Read abstract
Morrish et al., Radiology 2015, doi: 10.1148/radiol.14141508

Grivegnée
ECR 2015
"Volumetric approaches to breast density assessment are entirely consistent with the changes in the BI-RADS 5th edition…"
Read poster
Grivegnée, European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Schilling, The, Griff, Oliver, Mahal, Saady & Velasquez
ECR 2015
"Quantitative breast density software significantly improved interobserver agreement of experienced radiologists’ assessment of mammographic breast density."
Read scientific exhibit
Schilling et al., European Congress of Radiology, March 4-8, 2015, Vienna, Austria.

Gilbert, Duffy, Morrish, Tucker & Black
RSNA 2014
"A significantly improved sensitivity (p=0.02) was also observed for those at or above the third quartile of Volpara density (103 cm3) Volpara, with a sensitivity of 87% (95% CI 83-91 for 2D mammography alone and 93% (95% CI 90-96%) for 2D mammography plus DBT. No significant difference in sensitivity was observed for those with high density as measured by Quantra…"
Read abstract
Gilbert et al., Radiological Society of North America Annual Meeting, November 30 - December 05, 2014, Chicago IL.

Lee, Sohn & Han
Acta Radiol 2014
"Therefore, the use of automated software may help provide higher reproducibility, especially for patients with different bilateral breast densities... In conclusion, automated volumetric breast density measurement shows good agreement of BI-RADS density category as a quantitative method."
Read abstract
Lee et al., Acta Radiol 2014 [Epub ahead of print] pii: 0284185114554674

Vinnicombe, Evans, Hart & Whelehan
ECR 2014
"Variances between volumetric MD measurements using Volpara™, obtained from GE Senographe and Hologic Selenia mammograms in the same women one year apart, were small and equally distributed in both directions, whereas human visual density scores were statistically significantly more likely to be higher in Senographe mammograms."
View presentation
Vinnicombe et al., European Congress of Radiology, March 6-10, 2014, Vienna, Austria.

Gennaro, Baldan, Bezzon, Dal Bosco, Polico, Proietti & Pescarini
ECR 2014
"Volumetric breast density computer-based can remove inter-reader variability in categorization of dense breasts and following decisions about patient workup."
View presentation
Gennaro et al., European Congress of Radiology, March 6-10, 2014, Vienna, Austria.

Na & Sohn
ECR 2014
"The automated volumetric breast density measurement shows good agreement with radiologists’ visual assessment of BI-RADS density category as a quantitative method."
Read scientific exhibit
Na et al., European Congress of Radiology, March 6-10, 2014, Vienna, Austria.

McEntee & Damases
SPIE 2014
"A data set…was classified by twenty American Board of Radiology Examiners… An almost perfect correlation for AvBD% was shown between GE and Hologic systems… Automated systems demonstrated higher internal validity… Large inter and intra-reader variations of expert radiologists was demonstrated."
Read abstract
McEntee et al., Proceedings of SPIE 9037, Medical Imaging 2014, Image Perception, Observer Performance and Technology Assessment. February 15-20, 2014, San Diego, CA. doi: 10.1117/12.2042966

Bang, Kim, Cha, Shin & Chae
KCR 2013
"Our results showed the normal range of quantitative breast density parameters…in Korean women. These results could help to assess breast cancer risk and to stratify the optimized screening protocol in Korean women according to breast density."
Read abstract
Bang et al., 69th Korean Congress of Radiology and Annual Delegate Meeting of The Korean Society of Radiology, October 9-12, Seoul, South Korea.

Seo, Ko, Han, Ko, Shin & Hahn
Clin Radiol 2013
"VBD showed a highly significant positive correlation with visual assessment… Automated VBD is a reliable objective method to measure breast density."
Read abstract
Seo et al., Clin Radiol 2013; 68(7):690-5. doi: 10.1016/j.crad.2013.01.011

Gweon, Youk, Kim & Son
Am J Roentgenol 2013
"Our study showed good correlation of the fully automated volumetric method with radiologist-assigned BI-RADS density categories. Mammographic density assessment with the fully-automated volumetric methods may be used to assign BI-RADS density categories"
Read abstract
Gweon et al., Am J Roentgenol 2013; 201(3):692-7. doi: 10.2214/AJR.12.10197

Highnam, Chan & Sauber
ECR 2013
"…there appears to also potentially be a systematic bias country-by-country [in BIRADS density assessment]. Moving towards a more standardized approach to breast density assessments will aid…"
Read poster
Highnam et al., European Congress of Radiology, March 6-10 2013, Vienna, Austria. doi: 10.1594/ecr2013/C-1762